This page contains the findings of systematic reviews undertaken by the EPPI-Centre Health Promotion and Public Health Reviews Reviews Facility

One study [1] reviewed research evidence relating to accidental injury and risk-taking behaviour by young people aged 12-24. It covered drug and alcohol use, transport and sport.

Drug use

The review found that the use of drugs is associated with an increased risk of accidental death among young people and that 12–24 year olds are less at risk than those immediately older. However, risk of death increases with length of drug use, so there is value in targeting interventions at this age group.

Many more young men than women die from drug overdoses, because more men take drugs, but those women who do use drugs are at higher risk. Certain other groups of young people are more at risk than others. These include young people in deprived areas and men who have recently been released from prison.

There was a clear disjunction of views between young people who used drugs and those who did not. The young people who did not take drugs regarded them as risky and stated that media images about possible negative consequences dissuaded them from trying them, while those who did tended not to believe ‘official’ messages about possible harms and did not perceive taking drugs as being dangerous. Cannabis in particular was singled out as possibly being good for you, with some young people believing it to be cheaper than alcohol. The recent reclassification of cannabis and the subsequent debate may have helped to reinforce this view.

The burden of the more serious injuries – as demonstrated by the mortality statistics – is carried by young people in the lower socio-economic groups.

In road injuries, drugs are found in the bloodstream of more young fatal accident victims than older age groups; however, it is difficult to assess whether drugs actually contributed to the accident.

Driving on cannabis was thought to be more acceptable than drink-driving and not thought to be dangerous.

Alcohol use

Almost everyone admitted to hospital for alcohol poisoning is aged between 11 and 17. After a sharp peak among 14 and 15 year olds, hospital admissions for injuries with alcohol involvement decline slowly between the ages of 16 and 30.

Correlational studies have shown that alcohol puts the drinker at an increased risk of injury, that young people are more likely to have injuries than older people, and that young men are more at risk than young women. In the one study that examined ethnicity, minority ethnic status did not increase alcohol-related injuries, and may in fact have had a protective association.

Views studies found that young people say that they do not commonly mix alcohol and other drugs. Most young people reported that drinking places them at greater risk of injury, though some did not. The younger teenagers – 14 and 15 year olds – felt most in danger of injury when drinking. Young people felt that they learned to manage their drinking through experience and that unsupervised, outdoor drinking was the most dangerous and was more common among younger teenagers (with injuries being considered less common in licensed venues). Peers encourage both drinking and drunken pranks, but also protect one another when they have become more vulnerable as a result of drink. Young people felt that drinking reduces their perceptions of danger and some stated that injury as a result was inevitable. Most young people were cautious about getting very drunk, though being sick as a result of drinking is common and not regarded as serious. Bad experiences – whether to self or someone else – might change behaviour in the short- but not long-term.

One study which examined attempts to reduce alcohol-related injuries found some evidence that motivational interviews in A&E departments are more effective than information handouts.

See also drink-driving, below.

Road injuries

National statistics show that 10,900 young people were killed or seriously injured on the roads in the UK in 2004. Many more young men than women are injured, although the disparity is less among car passengers than for other forms of transport. Those aged under 16 are most at risk of injury on bicycles; at age 16, more are injured on mopeds, and then at 17 and over in cars. Young people aged 17–19 years are the most likely to be involved in drink-drive related accidents. The involvement of drugs in road traffic accidents has yet to be quantified.

Younger drivers are more likely to be injured than older drivers, but with motorcycles, the engine capacity correlated with the severity of the injuries.

In England and Wales, 16-24 year olds had more alcohol-attributed deaths than all other age groups, and young men in this age group had eight times as many deaths as young women. Drugs are found in the bloodstream of more young fatal accident victims than older age groups; however, it is difficult to assess whether drugs actually contributed to the accident.

A low score based on the father’s occupational classification and low family affluence have both been reported as being predictive of injuries occurring on the roads.

Young ‘risky’ drivers were more likely to think they would have an accident, but were also less worried about this than ‘safe’ drivers; ‘risky’ driving was seen as enjoyable and not considered to be the same as driving unsafely. Different drivers had different perceptions of what a ‘good driver’ was, with ‘safe’ drivers emphasising safety and ‘unsafe’ drivers emphasising driver skills.

Some passengers (e.g. parents) tend to reduce risky driving, whereas others (e.g. peers) might encourage more risky driving. Young men were more likely to take risks than young women.

Young people said they were more likely to drive riskily when driving alone or late at night when the roads are quieter than during the day. They drove less riskily when responsible for someone in the car. Some young people felt they ‘grew out’ of risky driving as they got older with more expensive cars and family responsibilities. They also said that the social expectation that they would drive riskily made it more likely that they would do so.

Raising the minimum driving age and introducing graduated licensing schemes for young people have also been shown to be effective in reducing accidents. Curfew laws, which restrict the times during which new drivers can drive, also reduce accidents. Seat belt campaigns have led to behaviour change and consequential reductions in injuries. While evidence of their effectiveness is increasing, community-based interventions have not yet demonstrated a sustained impact in reducing injury.

Drink-driving

Drink-driving was generally considered dangerous and not socially acceptable, whereas driving on cannabis was more acceptable and not thought to be dangerous. Some young people stated that a lack of public transport (or alternatives, such as taxis) made it more likely that they would drink and drive.

Interventions based on models of behaviour change to reduce drink-driving are ineffective or have a negative effect. Combining different approaches has more effect than using a single approach. Education or skills training has either negative or no effects on driver behaviour and subsequent accidents, possibly because these approaches lead to over-confidence or early licensing.

Legislation and enforcement on reducing drink-driving has been found to be effective.

Helmets

Legislation on the wearing of motorcycle helmets has been found to be effective.

Despite the debate on whether or not cycle helmets should be compulsory, the balance of evidence suggests that wearing helmets reduces injury in the event of an accident.

Young people did not think cycling was very risky and did not think that accidents would happen to them. Cycling conditions (e.g. at night or in bad weather) affected their perceptions of risk and some young people believed that helmets were only needed for certain types of journey. This differing risk perception for different types of journey did not predict the wearing of cycle helmets, only the intention to wear one.

Young people who ‘could never forgive themselves’ if they had an injury which a helmet could have prevented were more likely to wear one.

Young people differed in their perceptions about the protection offered by helmets, with some feeling that the head was not the part of the body most likely to be injured in an accident. Beliefs about the safety offered by helmets do not necessarily predict whether a young person is likely to wear one.

‘Critical incidents’ – whether to the young person or to someone known to them – were reported to change behaviour, but only in the short-term.

Most young people did not feel that wearing a helmet affected the way they cycled, though some expressed concern about the possibility that motorists would think they were less vulnerable and so drive more dangerously around them.

Peers tended to be a negative influence on the wearing of cycle helmets due to concerns about being teased, particularly when first starting to wear one. Parents were often a positive influence, and some young people felt legislation would also make them more likely to wear helmets. Young people also mentioned that cheaper and more attractive helmets would be more inviting to wear.

Education interventions through a single medium were not effective at increasing the wearing of cycle helmets, but multifaceted interventions were effective. Education interventions targeting small groups had mixed effects, with some studies reporting positive results and others finding no effect.

Some interventions which provided subsidised or free helmets did increase helmet use. There was conflicting evidence about the relative effectiveness of providing free and subsidised helmets. There is some evidence to suggest that promotional campaigns have more effect in high income areas, and also that younger children were more likely than teenagers to change their behaviour (especially girls). There is also some evidence to suggest that community-based interventions are more effective than interventions based in the school.

The balance of evidence suggests that a combination of legislation and enforcement is the most effective means of reducing cycling injury. However, the introduction of compulsory helmet wearing can also lead to a reduction in cycling. Some studies recommend a multi-faceted approach in which legislation is preceded by education and promotional campaigns.

Pedestrians

The only independent predictor of child pedestrian injury is ‘playing in the street’.

The effectiveness of pedestrian education is not proven. Environmental modification and the enforcement of speed limits may be more effective at pedestrian accident prevention.

Sport

The greatest numbers of sports-related injuries occur to young people playing football (27%) and rugby (10%), because these are the most widely played sports. When activity rates are taken into account, rugby is by a long way the most dangerous mass-participation sport. Stick-based sports, such as hockey, also have high injury rates, and eye injuries are more common in racquet sports. One study found that half of all injuries to young people in an accident and emergency department were sports related, and most studies which examined differential injury between sexes found that young men suffered more injuries than young women. The Health Survey for England found that sport/exercise accident rates peaked in young people between the ages of 13 and 15 years old.

Athletics injuries are reduced if a coach is present, and there is some evidence to suggest that adult/guard supervision can reduce injuries at swimming pools and beaches.

The use of custom-fitted mouthguards was found to reduce oral injuries in rugby and changes to the rules reduced very serious injuries in rugby and ice hockey. Similarly, the use of protective equipment reduced injuries to players of American Football, the use of belts benefited weightlifters, and eye/face protectors reduced squash injuries. For those with previous ankle sprains, ankle supports and taping were beneficial in reducing future sprains (in soccer and other sports, such as basketball). Specially designed baseball bases, which come away from the ground easily when players slide into them, were effective in lowering injury rates. Despite considerable research, there is little strong evidence to help runners avoid injury. Neither stretching nor warm up/down regimes appear to be associated with reduced rates of injury.

The environment in which sport takes place can affect injury rates. Smaller rinks are associated with more injuries in ice hockey, and the design of swimming pools can also change injury patterns. Removing monkey bars and increasing the depth of protective bark in public playgrounds can reduce injuries significantly. Reducing potential hazards in school playgrounds has also limited rates of injury.